Painful eye metastasis from Stage IV gastric cancer

What happened, in summary

A man in his late 50s was diagnosed with Stage IV gastric cancer after imaging showed a stomach tumor and multiple bone metastases. Gastric biopsy confirmed moderately differentiated tubular adenocarcinoma. Because the disease was already metastatic, he did not undergo gastric surgery and instead received systemic treatment with oxaliplatin and cetuximab.

About a year after the gastric cancer diagnosis, he developed pain and worsening vision in his left eye. Eye examination showed retinal detachment, bleeding, and a mass in the choroid. CT and MRI supported a metastatic tumor rather than a primary eye melanoma. His left eye was surgically removed because of the painful, destructive lesion.

Pathology showed metastatic moderately differentiated adenocarcinoma. The staining pattern and his known gastric cancer supported the stomach as the origin, establishing choroidal metastasis from the gastric cancer. The procedure relieved his eye pain and he initially recovered from surgery. However, he died 2 months later. His course illustrates an uncommon but serious site of spread in already advanced gastric cancer, presenting with eye pain and visual disturbance.